Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | 26417 | WV |
NPI | 1033340492 |
---|---|
Provider Name | Wail Ali |
First Address | Morgantown, WV 26505 |
Second Address | Mobile, AL 36604-3301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2009 |
Last Update Date | 08/01/2021 |